Letter to the Editor Open Access
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2024; 16(5): 1482-1484
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1482
Exploring predictive markers for liver failure post-hepatectomy in hepatocellular carcinoma patients
Shi-Yan Zhang, Xiong-Jian Ma, Xue-Xia Zhu, Na Cai, Department of Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding 355200, Fujian Province, China
ORCID number: Shi-Yan Zhang (0000-0003-4305-8213).
Author contributions: Zhang SY and Ma XJ designed and performed research; Zhu XX wrote the comment; and Cai N revised the comment. All the authors listed have read and approved the final manuscript.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi-Yan Zhang, MD, Director, Doctor, Department of Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, No. 120 South Road of Old City, Fuding 355200, Fujian Province, China. myebox@139.com
Received: February 1, 2024
Revised: April 9, 2024
Accepted: April 17, 2024
Published online: May 27, 2024
Processing time: 112 Days and 7 Hours

Abstract

This letter to the editor addresses the study titled “Predictive value of NLR, Fib4, and APRI in the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma” by Kuang et al in the World Journal of Gastrointestinal Surgery. The study acknowledges the comprehensive patient data analysis while suggesting that there is a need for further discussion on the clinical applicability of these markers across diverse patient populations. This letter recommends prospective studies for validation and considers the influence of confounding factors. This finding underscores the significance of this study in improving hepatocellular carcinoma management.

Key Words: Neutrophil-to-lymphocyte ratio; Hepatocellular carcinoma; Liver failure; Hepatectomy; Letter to the Editor; Commentary

Core Tip: Acknowledges the study's comprehensive analysis and its contribution to hepatocellular carcinoma management. These findings suggest further exploration of the clinical applicability of the neutrophil-lymphocyte ratio, fibrosis index based on four factors, and aspartate aminotransferase-to-platelet ratio index in diverse patient groups. Prospective studies for the validation of these findings are recommended. This highlights the importance of considering the confounding factors in future research.



TO THE EDITOR

We recently read the insightful study titled "Predictive value of NLR, Fib4, and APRI in the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma" by Kuang et al[1], which was published in the World Journal of Gastrointestinal Surgery. The study's exploration of neutrophil-lymphocyte ratio (NLR), fibrosis index based on four factors (Fib4), and aspartate aminotransferase-to-platelet ratio index (APRI) as predictive markers for liver failure post-hepatectomy in hepatocellular carcinoma (HCC) patients is commendable.

The researchers' meticulous approach to developing and validating a column-line graph prediction model based on these markers is a significant advancement in predicting postoperative complications in HCC patients. The use of a large sample size and the division of patients into modeling and validation cohorts strengthens the study's validity. The high concordance between predicted and actual events in the study emphasizes the potential of these markers as tools for better clinical decision-making[2].

However, several aspects could be enhanced or explored further[3]. First, while the present study effectively established the predictive value of the NLR, Fib4 levels, and APRI, it primarily focused on a retrospective patient cohort. Prospective studies could further validate these findings and assess their applicability in real-time clinical settings.

Moreover, the study's focus on a single hospital's patient cohort may limit the generalizability of the findings. A multicenter study encompassing diverse demographic and genetic backgrounds could provide a more comprehensive understanding of the predictive value of these markers across different populations[4].

Additionally, the paper briefly touches upon the potential impact of confounding factors such as underlying liver diseases, other comorbidities, and different treatment regimens. A more detailed exploration of how these factors might influence the predictive accuracy of the NLR[5], Fib4, and APRI would be beneficial. Such an analysis could lead to a more nuanced understanding of the limitations and scope of these biomarkers in clinical practice.

Another aspect worth considering is the practicality of implementing these predictive models in clinical settings. While the study presents a robust statistical model, the translation of these findings into a simple, accessible format for routine clinical use would be a significant step forward. This could include the development of an easily interpretable scoring system or a digital tool that can be integrated into existing hospital information systems.

Finally, this study opens avenues for exploring the role of these biomarkers in the broader spectrum of liver diseases and surgeries[6]. Future research could focus on whether these markers can predict outcomes in other liver surgeries or liver-related conditions, potentially broadening the scope of their clinical utility.

In conclusion, the study by Kuang et al[1] is a valuable addition to the field of hepatology and surgical oncology. This study not only advances our understanding of postoperative complications in HCC patients but also sets the stage for further research that could ultimately enhance patient outcomes and personalized treatment approaches.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Gastroenterology and hepatology

Country of origin: China

Peer-review report’s classification

Scientific Quality: Grade C

Novelty: Grade B

Creativity or Innovation: Grade B

Scientific Significance: Grade B

P-Reviewer: Abbas Z, Pakistan S-Editor: Qu XL L-Editor: A P-Editor: Zheng XM

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